| NPI | 1891260048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R228821) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC RN1047013) |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2024-11-19 |