| NPI | 1336035666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95038262) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 116023-23) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209034132) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407280) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 8371598) | |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2026-04-04 |