| NPI | 1093272668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: IA G163096) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A130250) |
| Enumeration Date | 2019-03-01 |
| Last Update Date | 2021-11-16 |