| NPI | 1689482630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024192569) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: VA 0001304657) |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: DC RN1043524) | |
| Enumeration Date | 2024-12-23 |
| Last Update Date | 2025-11-05 |