NPI | 1225681398 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61679982) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11003356) |
363LF0000X Nurse Practitioner, Family (Licence: WA AP61679982) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11003356) | |
Enumeration Date | 2019-07-18 |
Last Update Date | 2025-06-05 |