| NPI | 1750833984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 901732) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 22319) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61142303) | |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2021-08-20 |