| NPI | 1447940275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NC 2023063159) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 326799) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2023-08-10 |