| NPI | 1871195990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH -23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP022808) |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2024-07-13 |