| NPI | 1306671094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61609084) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10000505) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1176256) | |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2025-06-27 |