| NPI | 1902156326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 9598) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 9598-33) |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2022-07-26 |