| NPI | 1629654165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP500004284) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R204606) |
| 363LF0000X Nurse Practitioner, Family (Licence: DC NP500004284) | |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2023-08-18 |