| NPI | 1306198429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 321587) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95034292) |
| 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-5050) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 83016) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 873430) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10041249) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2025-04-02 |