| NPI | 1447514187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R149775) |
| Additional Taxonomies | 376G00000X Nursing Home Administrator (Licence: DC RN963469) |
| 174H00000X Health Educator | |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2023-01-20 |