NPI | 1669086641 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61096819) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP028851) |
Enumeration Date | 2020-09-07 |
Last Update Date | 2024-03-13 |