| NPI | 1841776044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-131347) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT 131347) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2021-03-18 |