| NPI | 1750658662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202210765NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN227176) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61321680) | |
| Enumeration Date | 2011-11-20 |
| Last Update Date | 2023-07-07 |