| NPI | 1790393825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: SD CP001775) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IA 71011345A) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NE 113462) | |
| Enumeration Date | 2020-07-15 |
| Last Update Date | 2022-04-01 |