| NPI | 1346762580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 087987-23) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP221615) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024195497) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 22766) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0136324) | |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2026-02-18 |