| NPI | 1811329006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WI 6328-33) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WY 32480.1258) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2018-03-17 |