| NPI | 1679965610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 221798) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 146918) |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2021-08-14 |