| NPI | 1063924108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11032161) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1032682) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61356809) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95022558) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.030973) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10040453) | |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2025-06-20 |