| NPI | 1811530504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP021413) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA NPPA040645) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R192477) | |
| Enumeration Date | 2019-10-24 |
| Last Update Date | 2022-02-01 |