| NPI | 1861843062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP022055) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN643734) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2021-07-07 |