NPI | 1730895327 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61680532) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 773088) |
Enumeration Date | 2023-01-26 |
Last Update Date | 2025-06-05 |