| NPI | 1720553795 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-114314) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AL 1-114314) |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2019-05-20 |