| NPI | 1265981831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61205271) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OK R 0120885) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2024-06-25 |