| NPI | 1063962140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8501433-4405) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CT 128181) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: UT 8501433-3102) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2022-07-21 |