| NPI | 1689157331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R162583) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1026502) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R199900) | |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2022-06-01 |