NPI | 1942001508 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/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 |