| NPI | 1316432172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R236682) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R236682) |
| 163W00000X Registered Nurse (Licence: PA RN563906) | |
| 163W00000X Registered Nurse (Licence: DC RN1041295) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP1041295) | |
| Enumeration Date | 2018-06-25 |
| Last Update Date | 2021-10-14 |