| NPI | 1205346335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 7277) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2322499) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 092708-23) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP033069) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11029497) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0033275) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405826) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10025640) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 7277) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024189530) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1140771) | |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2025-12-09 |