| NPI | 1083500029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP034144) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: PA RN741817) |
| Enumeration Date | 2025-06-16 |
| Last Update Date | 2025-10-12 |