| NPI | 1730771320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2022003808) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61140870) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-80457-022) | |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2025-01-27 |