| NPI | 1184303075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277004924) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407160) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11032341) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 321388) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 881317) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1016468) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP70002237) | |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2026-03-24 |