| NPI | 1568633584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: OR 200950161NP) |
| Additional Taxonomies | 163WP0807X Registered Nurse Psychiatric/Mental Health, Child & Adolescent (Licence: CA RN 732662) |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: IL 041330155) | |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: OR 200943049RN) | |
| 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult (Licence: CA RN 732662) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA NP 18356) | |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2012-03-27 |