| NPI | 1801245998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10007039) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP131038) |
| 363L00000X Nurse Practitioner (Licence: TX AP131038) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 804973) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61228405) | |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2025-09-18 |