| NPI | 1164960720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9359865) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WA AP60792299) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: AZ AP11258) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9359865) | |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2022-06-07 |