| NPI | 1538613179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN203405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN203405) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2020-02-06 |