| NPI | 1366003733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: LA 203158) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: LA 203158) |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: LA 203158) | |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2024-07-30 |