| NPI | 1891495784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2023006943) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011022715) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2024-05-01 |