| NPI | 1568191088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 10666184-4405) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 856732) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 2777) | |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2024-11-06 |