| NPI | 1720859788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 093241-23) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CO RN.1667128) |
| Enumeration Date | 2024-01-09 |
| Last Update Date | 2024-07-16 |