| NPI | 1942001508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MD R219331) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: MD R219331) |
| Enumeration Date | 2025-03-20 |
| Last Update Date | 2025-07-31 |