| NPI | 1346767696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP023043) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN639375) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP018242) | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2022-07-21 |