| NPI | 1649020850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R239579) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD 787140) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MD 787140) | |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: MD 787140) | |
| Enumeration Date | 2024-03-22 |
| Last Update Date | 2024-05-22 |