| NPI | 1124803192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61478064) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA N361481193) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2268072) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95026895) | |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2023-12-20 |