| NPI | 1720645666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202214466NP) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 202214179RN) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP141677) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP141677) | |
| Enumeration Date | 2019-05-27 |
| Last Update Date | 2023-12-28 |