| NPI | 1073155933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2020002143) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2020002143) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2024-05-29 |