| NPI | 1205120235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202112766NP-PP) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31998) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95012595) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61234668) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ND R51807) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 272711) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2022-04-22 |