| NPI | 1548077910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10036040) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 31550) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA 361644690) | |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2024-12-18 |