| NPI | 1265194369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9531433) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 65515) | |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2023-03-30 |