| NPI | 1578986915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 880514) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MS 880514) |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2022-09-02 |