| NPI | 1154189538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5020249) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NC 287014) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-07-19 |