| NPI | 1750861621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NE 112557) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NE 112557) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NE 112557) | |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2026-08-25 |