| NPI | 1154190171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP1042803) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R202791) |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2024-01-02 |