| NPI | 1568974822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID NP67131) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: ID NP67131) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP60967912) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IA G140540) | |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2021-06-24 |