| NPI | 1427564137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 209483) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: LA 094013) |
| 363LF0000X Nurse Practitioner, Family (Licence: LA 209483) | |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2025-09-23 |