| NPI | 1548948912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 12.012278) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 10.187370) |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2023-08-30 |