| NPI | 1851155279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 35884) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA GAA-NP002196) |
| Enumeration Date | 2024-02-07 |
| Last Update Date | 2024-12-23 |