| NPI | 1518314681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R220724) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1040614) |
| 163W00000X Registered Nurse (Licence: MD R220724) | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2023-08-08 |