| NPI | 1659659100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP66372) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN66372) |
| 163W00000X Registered Nurse (Licence: MD R137573) | |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2023-04-13 |