| NPI | 1316338924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2015003166) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2009019530) |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2018-07-13 |