| NPI | 1710191168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ AP5533) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: WA AP60050270) |
| 363LX0106X Nurse Practitioner Occupational Health (Licence: WA AP60050270) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: AZ AP5534) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2016-07-09 |