| NPI | 1316568561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 15529-33) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 196593) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2024-11-21 |