| NPI | 1609386440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0001023-C-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60951772) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2022-11-28 |