| NPI | 1285368969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R163969) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2022-07-11 |