| NPI | 1639530785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61084234) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP137374) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 197364) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 189551) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP137374) | |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2023-07-24 |