| NPI | 1518580992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5021808) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5021808) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: NC 248905) | |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2026-01-07 |