NPI | 1558089029 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R230341) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R230341) |
Enumeration Date | 2022-08-19 |
Last Update Date | 2025-09-29 |