| NPI | 1063058931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NH 080639-23) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: NH 080639-21) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2022-01-25 |