| NPI | 1407461429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-161265) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 4023847) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 8971483) | |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2026-03-16 |