| NPI | 1649413758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R253173) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MD u01817) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MD R253173) | |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2024-09-12 |