| NPI | 1942718614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R203322) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD R203322) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95006346) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024193714) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP030655) | |
| Enumeration Date | 2018-01-16 |
| Last Update Date | 2025-12-09 |