| NPI | 1548799141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1099855) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 320878-1) |
| 163WA2000X Registered Nurse, Administrator (Licence: TX 958104) | |
| 171M00000X Case Manager/Care Coordinator (Licence: TX 958104) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61366158) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-07-15 |