| NPI | 1528086220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 348533) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: WI 101665030) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: WI 3485-33) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-03-07 |