| NPI | 1760118947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN328697) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2326935) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA RN2326935) | |
| Enumeration Date | 2022-07-28 |
| Last Update Date | 2024-11-15 |