| NPI | 1619741279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R218066) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010767) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024189670) | |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2025-07-10 |