| NPI | 1255515896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024181268) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00010956) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-RXN.0001416-C-NP) | |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: TN 22909) | |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2021-08-11 |