| NPI | 1336461813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 214786) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202102494NP-PP) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP9700) | |
| 163W00000X Registered Nurse (Licence: NC MSL214785NC) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 218849) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 10886-33) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 8270) | |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2024-06-21 |