| NPI | 1184046781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WI 5643-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 5643) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2025-09-07 |