| NPI | 1144167909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 48943) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WY 48943) |
| 363L00000X Nurse Practitioner (Licence: WY 48943) | |
| Enumeration Date | 2026-04-30 |
| Last Update Date | 2026-07-22 |