| NPI | 1063065209 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 26280) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 202127) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2021-10-25 |