| NPI | 1154871036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61043877) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP61043877) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP131565) | |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2023-02-27 |