| NPI | 1760713945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5004634) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024177401) |
| 163W00000X Registered Nurse (Licence: NC 194534) | |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2026-05-28 |