| NPI | 1518492479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP60919662) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: ID 55498) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: ID 55498) | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2022-11-25 |