| NPI | 1760058424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2021019843) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2021019843) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2022-08-19 |