| NPI | 1538709092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61098454) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NC 277126) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5012834) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 836257) | |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2023-02-22 |