| NPI | 1356896377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 16635) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: TN 16635) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2024-03-11 |