| NPI | 1598400350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5013886) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5013886) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5013886) | |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2022-06-22 |