| NPI | 1922724186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G173810) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IA 152544) |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2023-04-11 |