| NPI | 1275256992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R214086) |
| Additional Taxonomies | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: MD R214086) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 125356) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024195935) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71017850A) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405486) | |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2026-06-04 |