| NPI | 1134844004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 906031) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS R894559) |
| Enumeration Date | 2022-10-04 |
| Last Update Date | 2023-06-24 |