| NPI | 1699534586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10023455) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 242328) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 0036368) | |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2024-05-06 |