| NPI | 1336683440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10002296APRN) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 10002296RN) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60808469) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP132780) | |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2023-04-05 |