| NPI | 1679292916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 905789) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 884204) |
| 363LS0200X Nurse Practitioner, School (Licence: MS 884204) | |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2023-05-17 |