| NPI | 1366003733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: LA 203158) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: LA 203158) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2022-12-29 |