| NPI | 1174878532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60302471) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 775764) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP8787) | |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2023-01-03 |