| NPI | 1407961584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 2466-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 2466) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2021-12-01 |