| NPI | 1619516069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 27045) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: TN 219467) |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2023-05-17 |