| NPI | 1720365158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010440) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: DE L8-0010440) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: DE L8-0010440) | |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2023-06-28 |