| NPI | 1780270538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP022609) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP022609) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: PA SP022609) | |
| Enumeration Date | 2020-12-16 |
| Last Update Date | 2025-01-30 |