| NPI | 1245787381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 226881) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN135048) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: LA RN135048) | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2022-08-15 |