| NPI | 1558850651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 9331-33) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WI 30-152760) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2023-07-26 |