| NPI | 1174313969 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 39790) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 281520) |
| Enumeration Date | 2025-05-07 |
| Last Update Date | 2025-10-06 |