| NPI | 1326518085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP139255) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 262597) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 64096) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 9328) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407779) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277001861) | |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2025-12-02 |