| NPI | 1386142586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8035016-4405) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: UT 1275547507) |
| 364SF0001X Clinical Nurse Specialist, Family Health (Licence: UT 8035016-4405) | |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2020-01-06 |