| NPI | 1760766208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ 229481) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2008006146) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MO 2018025246) | |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2020-09-21 |