| NPI | 1821481466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 2014020742) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 5380755051) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2021-12-10 |