| NPI | 1982164943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61114935) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11009355) |
| 163W00000X Registered Nurse (Licence: FL RN9418900) | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2020-12-31 |