| NPI | 1306478581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5012815) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 243188) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5012815) | |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2023-03-16 |