| NPI | 1770182776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: SC 254959) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 26683) |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2022-10-11 |