| NPI | 1780238584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 9444-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 9444-33) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2024-07-26 |