| NPI | 1124538764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9254956) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60961251) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 077529-23) | |
| Enumeration Date | 2017-10-10 |
| Last Update Date | 2022-01-27 |