| NPI | 1184230377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AL 1-109733) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: AL 1-109733) |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2020-09-22 |