| NPI | 1912688136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OR 10009510) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61459903) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2024-04-17 |