| NPI | 1790186161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 5988-33) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 5988-33) | |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2024-06-04 |