| NPI | 1427317080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R213812) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2020-10-19 |