| NPI | 1326655689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC MG9670476) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ND R42002) |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2025-11-05 |