| NPI | 1114504891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 884537) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R212265) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61423779) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202209563NP-PP) | |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2025-09-29 |