| NPI | 1003519372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61423786) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-82167-102) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704370314) | |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2023-07-13 |