| NPI | 1881052314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 228990) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN107776) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2023-01-11 |