| NPI | 1518622455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP027026) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP024827) |
| 163W00000X Registered Nurse (Licence: PA RN674446) | |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2025-02-13 |