| NPI | 1740905124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 12300) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CT 20186) |
| Enumeration Date | 2022-10-07 |
| Last Update Date | 2023-08-31 |