| NPI | 1922731470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G170194) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ TEMP276517) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61337914) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 847938) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 276517) | |
| 163W00000X Registered Nurse (Licence: IA 169476) | |
| 163W00000X Registered Nurse (Licence: NV 847938) | |
| 163W00000X Registered Nurse (Licence: AZ 276517) | |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2023-11-11 |