| NPI | 1588425540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010669) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0040721) |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-08-02 |