| NPI | 1073059259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60989975) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0000823-C-NP) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G145896) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NE 111689) | |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2023-10-15 |