| NPI | 1932646163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 32154) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024174317) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024174317) | |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2022-12-15 |