| NPI | 1538598487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202002776NP-PP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61231272) |
| 163W00000X Registered Nurse (Licence: OR 202002591RN) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: IL 041393235) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61231376) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209017885) | |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2023-03-01 |