| NPI | 1992476410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R245785) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R245785) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP026564) | |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2026-04-22 |