| NPI | 1942817648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN265029) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA 2022061663) |
| Enumeration Date | 2020-09-26 |
| Last Update Date | 2023-11-08 |