| NPI | 1609631209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OK 218671) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0102664-C-NP) |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2025-10-15 |