| NPI | 1427754191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61406192) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 8045752-4405) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10016581) | |
| Enumeration Date | 2023-02-03 |
| Last Update Date | 2024-08-15 |