| NPI | 1588292700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61143602) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP145334) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 10013-33) | |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2023-03-10 |