| NPI | 1427480136 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI 4024) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 23363) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2025-01-24 |