| NPI | 1336783893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61025855) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11004760) |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2021-11-15 |