| NPI | 1376583674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: WA AP30006444) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA VP003048C) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WV 67233) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA VP003048C) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 67233) | |
| 363L00000X Nurse Practitioner (Licence: WI 3850) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 3850) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2017-03-22 |