| NPI | 1447732441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R194343) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R194343) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024184303) | |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2025-05-08 |