| NPI | 1982065991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 6683-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 6683-33) |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2022-03-15 |