| NPI | 1093360380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 9649) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 31574-31) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2021-12-03 |