| NPI | 1639509888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201502375NP-PP) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 200842665RN) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71012936A) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61252566) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 69022) | |
| Enumeration Date | 2013-11-24 |
| Last Update Date | 2024-11-06 |