| NPI | 1053757690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: FL RN9560860) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MI 4704268271) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2022-02-22 |