| NPI | 1528773793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 14696) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP027570) |
| 163W00000X Registered Nurse (Licence: PA RN691750) | |
| Enumeration Date | 2023-01-20 |
| Last Update Date | 2026-03-20 |