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 |