| NPI | 1710660139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC 500013883) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 818269) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2024-11-15 |