| NPI | 1518265487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010317) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101Y00000X Counselor (Licence: DE Q1-0001180) | |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2024-09-18 |