| NPI | 1881367399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 12289) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 12289) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 8352) | |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2023-08-31 |