| NPI | 1952099178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R212081) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD R212081) |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2024-11-26 |