| NPI | 1912634593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN265613) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 307838) |
| 363L00000X Nurse Practitioner (Licence: ND 200607) | |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN265613) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61572854) | |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2025-08-28 |