| NPI | 1013426717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 23466) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 23466) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2022-07-21 |