| NPI | 1609631209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OK 218671) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: LA 211314) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 211314) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1167659) | |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-07-17 |