| NPI | 1821676669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61289252) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WA RN61287688) |
| 163W00000X Registered Nurse (Licence: OH RN.445266) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 0029697) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2024-04-25 |