| NPI | 1093965816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 13689-33) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: HI 48298) |
| 363L00000X Nurse Practitioner (Licence: WI 13689-33) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: ID 27171) | |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2023-05-22 |