| NPI | 1881286995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OK 210536) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK R0131069) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: OK R0131069) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OK R0131069) | |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: OK R0131069) | |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2022-10-13 |