| NPI | 1922587120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DC NP1014579) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024176461) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R182905) | |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2024-07-05 |