| NPI | 1417159849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202100768NPPP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 202100768NPPP) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61186015) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2025-11-02 |