| NPI | 1114624509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NV 864023) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV 8119855) |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2023-06-16 |