| NPI | 1023641743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202108944NP-PP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95017588) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 836571) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 47689) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61160807) | |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2022-06-22 |