| NPI | 1457964843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL 11013737) |
| Additional Taxonomies | 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: IN 28243714A) |
| 163WP0807X Registered Nurse Psychiatric/Mental Health, Child & Adolescent (Licence: IN 28243714A) | |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: IN 28243714A) | |
| 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult (Licence: IN 28243714A) | |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2025-05-01 |