| NPI | 1275490070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-284858) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MT NUR-APRN-LIC-284858) |
| Enumeration Date | 2026-01-06 |
| Last Update Date | 2026-01-19 |