| NPI | 1215579602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 826867) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 13033248-4405) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95028935) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NV 826867) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11004595) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 13033248-4405) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11004595) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 13033248-4405) | |
| 363L00000X Nurse Practitioner (Licence: AZ 321570) | |
| 363L00000X Nurse Practitioner (Licence: WA AP70043277) | |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2026-06-30 |