| NPI | 1558240366 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 287576) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ 287576) |
| Enumeration Date | 2025-08-27 |
| Last Update Date | 2025-09-25 |