| NPI | 1316401706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WI 9018-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WI 9081) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2022-03-31 |