| NPI | 1982863924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 22375) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN121613) |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: GA rn 136220) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2026-07-06 |