| NPI | 1134884356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1058783) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SD CP003330) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11034135) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95031193) | |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2025-12-08 |