| NPI | 1184468118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61579845) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 80010) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ RNP312924) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP241300) | |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2025-09-03 |