| NPI | 1427306232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10005773) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R189202) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0996417-NP) | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2026-02-06 |