| NPI | 1265215602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: GA RN322175) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN322175) |
| Enumeration Date | 2023-08-18 |
| Last Update Date | 2024-05-20 |