| NPI | 1376118182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 2023059114) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001271003) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2023-06-23 |