| NPI | 1902543374 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10042777) | 
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA RN95280648) | 
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 81552) | |
| Enumeration Date | 2022-05-17 | 
| Last Update Date | 2025-07-24 |