| NPI | 1982916607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R157620) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD r157620) |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2021-08-11 |