| NPI | 1811615222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: AL 7233) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 2598) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2025-07-24 |