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 |