| NPI | 1467029330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010255) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R228652) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2023-12-08 |