| NPI | 1346962214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5017493) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 314831) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2023-01-13 |