| NPI | 1679106702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61386834) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 119336) |
| 163WC0400X Registered Nurse, Case Management (Licence: OK 119336) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OK 119336) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 71175) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1016901) | |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2025-04-01 |