| NPI | 1720030406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP30004998) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN114639) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-08-11 |