| NPI | 1700404274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 5202116-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 5202116-4405) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2023-11-27 |