| NPI | 1144937343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11022519) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 111148-23) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-237887) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10001326) | |
| Enumeration Date | 2022-10-28 |
| Last Update Date | 2024-11-04 |