| NPI | 1114642600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: PA SP026430) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: PA RN700632) |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2024-02-22 |