| NPI | 1932641982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM CNP03107) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NM CNP03107) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NM CNP-03107) | |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2023-05-26 |