| NPI | 1437565629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT 100846) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT 39799) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2025-07-01 |