| NPI | 1346723970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R194744) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: DC RN1022843) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC RN1022843) | |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2021-09-01 |