| NPI | 1821676669 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA NPF95024532) | 
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WA RN61287688) | 
| 163W00000X Registered Nurse (Licence: OH RN.445266) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 0029697) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61289252) | |
| Enumeration Date | 2021-04-01 | 
| Last Update Date | 2025-02-04 |