| NPI | 1215488879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 31957) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60705831) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 264478) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WA RN60701519) | |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2026-01-12 |