| NPI | 1952350563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP30003889) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 081001194N6) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2024-02-23 |