| NPI | 1225677982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 58948) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NM RN-76601) |
| Enumeration Date | 2019-12-29 |
| Last Update Date | 2024-05-30 |