| NPI | 1144757832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-147487) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: AL 1-147487) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2024-10-24 |