| NPI | 1134621170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R214455) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: MD R214455) |
| 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: MD R214455) | |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2023-01-21 |