| NPI | 1174825293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WI 8816-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 149320-30) |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2020-03-24 |