| NPI | 1699467019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R224806) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1047223) |
| Enumeration Date | 2023-05-24 |
| Last Update Date | 2023-08-24 |