| NPI | 1841900305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 13547) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 11179) |
| 163W00000X Registered Nurse (Licence: CT 197887) | |
| Enumeration Date | 2022-11-24 |
| Last Update Date | 2024-08-21 |