| NPI | 1104452416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61115995) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC004069) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP145519) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 086453-23) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95014324) | |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2024-04-18 |