| NPI | 1619526423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NH 078049-23) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NH 078049-23) |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2024-12-26 |