| NPI | 1174365563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NE 115505) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 62325) |
| Enumeration Date | 2024-06-07 |
| Last Update Date | 2024-09-11 |