| NPI | 1871331009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI APRN-3987) |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry (Licence: HI APRN-3987) |
| 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-3987) | |
| Enumeration Date | 2024-07-20 |
| Last Update Date | 2025-10-14 |