| NPI | 1750137055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AR 230835) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN10038747) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 115765-23) | |
| Enumeration Date | 2024-04-26 |
| Last Update Date | 2026-07-08 |