| NPI | 1558731919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 226873) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: LA 149101) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2024-08-16 |