| NPI | 1548931116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5015077) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NC 338490) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: VA 0001270450) | |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2021-09-23 |