| NPI | 1992253082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 3-001136) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 905672) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MS R895162) | |
| Enumeration Date | 2016-09-17 |
| Last Update Date | 2023-11-21 |