| NPI | 1992055271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R174190) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R174190) |
| 363LF0000X Nurse Practitioner, Family (Licence: DC RN1016041) | |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2020-05-13 |