| NPI | 1609364520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5016124) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 28169) |
| 163W00000X Registered Nurse (Licence: NC 281689) | |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-01-16 |