| NPI | 1811613433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406781) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: GA RN291021) |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2025-03-25 |