| NPI | 1083171326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA APRN-NP219889) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN219889) |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2025-10-23 |