| NPI | 1952941536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61016243) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0996853-NP) |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2024-05-16 |