| NPI | 1861253676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 274446) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 37466) |
| Enumeration Date | 2024-01-18 |
| Last Update Date | 2025-03-26 |