| NPI | 1851240915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10056381) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 10357449-4405) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP70097585) | |
| Enumeration Date | 2026-01-22 |
| Last Update Date | 2026-06-03 |