| NPI | 1619757820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 14675-33) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WI 252205) |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2023-11-01 |