| NPI | 1457584740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G135784) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 135784) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2025-08-15 |