| NPI | 1831626894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 8165) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 28212365A) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407875) | |
| Enumeration Date | 2017-05-20 |
| Last Update Date | 2025-12-08 |