| NPI | 1659836609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: WI 8882-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 8882-33) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WI 8882-33) | |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2024-06-05 |