| NPI | 1801390034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R213171) |
| Additional Taxonomies | 251E00000X Home Health (Licence: MD R4216P) |
| 163W00000X Registered Nurse (Licence: DC 1035173) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2026-08-10 |