| NPI | 1649573346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R203481) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN215628) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024183634) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 5773) | |
| Enumeration Date | 2010-12-19 |
| Last Update Date | 2023-02-20 |