| NPI | 1982324034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024185257) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001292835) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2022-09-15 |