| NPI | 1013571561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5011813) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NC 259677) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2025-09-24 |