| NPI | 1992521124 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024197629) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001274056) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2026-06-25 |