| NPI | 1194448258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 32580) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 194463) |
| Enumeration Date | 2022-09-23 |
| Last Update Date | 2023-03-30 |