| NPI | 1457241721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA 300852) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: NY 762375) |
| Enumeration Date | 2025-07-08 |
| Last Update Date | 2025-07-08 |