| NPI | 1740093822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 14257471-4405) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OK 218778) |
| 163W00000X Registered Nurse (Licence: OK 218778) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP70077426) | |
| Enumeration Date | 2025-01-31 |
| Last Update Date | 2026-02-05 |