| NPI | 1073262911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 905362) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MS 886343) |
| Enumeration Date | 2022-03-19 |
| Last Update Date | 2022-07-25 |