| NPI | 1073091963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 902766) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 876372) |
| 363LF0000X Nurse Practitioner, Family (Licence: MS 902766) | |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2024-04-17 |