| NPI | 1447712443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-153584) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-153584) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: AL 1-153584) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2022-02-10 |