| NPI | 1215433586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA 60828888) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60769927) |
| 163W00000X Registered Nurse (Licence: NY 643918) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401958) | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2018-08-14 |