| NPI | 1104542109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 58976) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID TEMP58976) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1112901) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI APRN-3981) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61409196) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 865047) | |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2026-08-25 |