| NPI | 1245789957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 062313-23) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 062313-21) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2024-04-10 |