| NPI | 1588272611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 30068) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000207379) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: TN RN207379) | |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2021-08-12 |