| NPI | 1750062105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP028729) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN725063) |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2025-04-04 |