| NPI | 1730533589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R207930) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R207930) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP1031475) | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2025-09-17 |