| NPI | 1013543354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: SC 16543) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 16543) |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2023-04-28 |