| NPI | 1912379876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 64187) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0163261) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: NM RN-71867) | |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2023-06-08 |