| NPI | 1003690314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10011485) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61468824) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT APRN-218080) | |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2023-09-22 |