| NPI | 1861103137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2023033314) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MO 2020030713) |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2023-08-18 |