| NPI | 1487163184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 7850-33) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 7850-33) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2025-03-13 |