| NPI | 1649928698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NC CUNN-H1829) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NC 5016175) |
| Enumeration Date | 2022-03-17 |
| Last Update Date | 2022-12-16 |