| NPI | 1073247532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 13460) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CT 120395) |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2024-09-05 |