| NPI | 1437783545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP021762) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: PA RN572643) |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2024-02-15 |