| NPI | 1740971761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R193356) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD R193356) |
| 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry (Licence: MD R193356) | |
| Enumeration Date | 2023-05-19 |
| Last Update Date | 2023-05-19 |