| NPI | 1245967967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 13336-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 251824) |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2022-11-30 |