| NPI | 1528536364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61572187) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10032825) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R195260) | |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2024-10-08 |