| NPI | 1962176339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA 61212361) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202106873NP-PP) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2023-10-03 |