| NPI | 1306328497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP1038354) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: DC RN1038354) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2025-03-30 |