| NPI | 1972283182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 13867491-4405) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR 10011110) |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2024-08-08 |