| NPI | 1043988108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 223822) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71012944A) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-RXN.0002269-C-NP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61287233) | |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2024-10-10 |