| NPI | 1407637895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 13775) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 196780) |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2025-01-04 |