| NPI | 1396223897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 8556) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 6522) |
| 363L00000X Nurse Practitioner (Licence: WI 8556) | |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2026-05-27 |