| NPI | 1912634593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61572854) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: GA RN265613) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2024-10-07 |