| NPI | 1114763380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R251564) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: DC RN1041013) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP1041013) | |
| Enumeration Date | 2024-07-06 |
| Last Update Date | 2025-07-23 |