| NPI | 1225851629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5021379) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406639) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010760) | |
| Enumeration Date | 2024-11-04 |
| Last Update Date | 2025-02-09 |