| NPI | 1548135577 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 17463-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 17463-33) |
| Enumeration Date | 2025-10-08 |
| Last Update Date | 2026-05-21 |