| NPI | 1861604431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD 2025000569) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: MD R145701) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2025-05-06 |