| NPI | 1548909500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R224004) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD R224004) |
| Enumeration Date | 2022-05-29 |
| Last Update Date | 2024-02-14 |