| NPI | 1336677319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024174879) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024174879) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2359804) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC002189) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV CS37757) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11006676) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC RN1056068) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2025-06-09 |