| NPI | 1588373377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA GAA-NP001749) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 266107) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2023-10-12 |