| NPI | 1932919321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11037062) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 83525) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F406990-01) | |
| Enumeration Date | 2025-01-09 |
| Last Update Date | 2025-10-13 |