| NPI | 1962072736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8630565-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8630565-3102) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8630565-3102) | |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2022-04-13 |