| NPI | 1033793658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 10453) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 103107) |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2022-03-14 |