| NPI | 1326432287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024181190) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001301606) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2025-01-12 |