| NPI | 1619574936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2021002799) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MO 2008018755) |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2024-10-01 |