| NPI | 1316531254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 15423-30) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: WI 241852) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 15423) | |
| Enumeration Date | 2021-02-22 |
| Last Update Date | 2024-10-29 |