| NPI | 1851762025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024182789) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP1008861) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC003989) | |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2024-09-09 |