| NPI | 1336892801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5017839) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 218638) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2023-05-11 |