| NPI | 1346479995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: AZ AP3397) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP60911380) |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2019-01-01 |