| NPI | 1891308094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 65554) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP6140750) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: ID 65554) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202011497) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 13567379-4405) | |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2025-04-29 |