| NPI | 1255082814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA APRN-NP234943) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN234943) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404630) | |
| Enumeration Date | 2022-01-15 |
| Last Update Date | 2025-12-11 |