| NPI | 1366705634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA APO6828) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: LA LA89100) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2014-05-29 |