| NPI | 1477398493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61568401) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.477498) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2024-11-06 |