| NPI | 1972065902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL 11009362) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9328427) |
| Enumeration Date | 2019-03-31 |
| Last Update Date | 2024-06-12 |