| NPI | 1225658081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 59977) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: NM 59977) |
| 101YM0800X Counselor, Mental Health (Licence: NM 59977) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NM 59977) | |
| 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: NM 59977) | |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: NM 59977) | |
| 364SI0800X Clinical Nurse Specialist, Informatics (Licence: NM 59977) | |
| 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: NM 59977) | |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2020-04-22 |