| NPI | 1871370346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 217259) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 217259) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: LA 217259) | |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2025-11-06 |