| NPI | 1659116408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP70035795) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0036699) |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2026-01-08 |