| NPI | 1740827591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5016146) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 249482) |
| Enumeration Date | 2019-11-27 |
| Last Update Date | 2023-04-17 |