| 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 |