| NPI | 1750821070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R210938) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1029201) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2020-10-05 |