| NPI | 1073089801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010461) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0054237) |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2023-07-07 |