| NPI | 1740801299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 092467-23) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 130335) |
| Enumeration Date | 2020-05-06 |
| Last Update Date | 2025-03-05 |