| NPI | 1194442558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R221983) |
| Additional Taxonomies | 364SP0812X Clinical Nurse Specialist, Psych/Mental Health, Community (Licence: MD R221983) |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2023-11-02 |