| NPI | 1548045255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WY 46776) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WY 46776) |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2024-10-07 |