| NPI | 1326584640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 55936) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID 55936) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: ID RN-41181) | |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2022-02-21 |