| NPI | 1801594551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP027337) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN695003) |
| 163W00000X Registered Nurse (Licence: NJ 26NR22393400) | |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2023-05-31 |