| NPI | 1962057646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 26666) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 233089) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2019-10-18 |