| NPI | 1053943688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: ID 63745) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 63745) |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2025-05-28 |