| NPI | 1407629975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R236391) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: DC RN1055358) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2025-09-17 |