| NPI | 1386091676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 65298) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: ID NP65298) |
| 363LF0000X Nurse Practitioner Family (Licence: ID 65298) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: ID 65298) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61360767) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95004065) | |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2023-05-27 |