| NPI | 1356942338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MO 2021005041) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2016020071) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2021-02-11 |