| NPI | 1922521293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024180490) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN251444) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2021-06-04 |