| NPI | 1629848098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AR 213657) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR 213657) |
| Enumeration Date | 2024-01-05 |
| Last Update Date | 2024-09-30 |