| NPI | 1114181989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA RN00164186) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60045999) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 11996960) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2021-07-08 |