| NPI | 1902203367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10009817) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60801886) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60801886) | |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2024-08-21 |