| NPI | 1215535588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL 11008497) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11008497) |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2024-03-07 |