| NPI | 1598217176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61127400) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71006657A) |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2022-04-18 |