| NPI | 1932292067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5004021) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: TN rn0000098770) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC 3050) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2025-05-15 |