| NPI | 1417485491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN187257) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN187257) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2025-10-27 |