| NPI | 1831454487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP1014554) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1014554) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2025-03-28 |