| NPI | 1881064830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61126042) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN169166) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: GA RN169166) | |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2024-05-16 |