| NPI | 1811752595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 36574) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10029681) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11033698) | |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2025-03-18 |