| NPI | 1922994789 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN245383) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN245383) |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-06-19 |