| NPI | 1669080933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024179871) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 2371434) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 011163) | |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2023-03-06 |