| NPI | 1144674581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA 233148) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN233148) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2024-07-22 |