| NPI | 1770323222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 235940) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN122549) |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-07-09 |