| NPI | 1497511307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 28538) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 245841) |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2025-11-19 |