| NPI | 1992311823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95020754) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95281954) |
| 163W00000X Registered Nurse (Licence: WA RN60865339) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61172870) | |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2023-11-20 |