| NPI | 1437528858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95003125) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95003125) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OR 202203363NP-PP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202203889NP-PP) | |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2024-07-07 |