| NPI | 1629550215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201908982NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60896898) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 6148) | |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2024-03-12 |