| NPI | 1578106217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202209315NP-PP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 35266) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP144841) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202209114RN) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 840583) | |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2025-03-25 |