| NPI | 1366118671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 270410) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 2021028178) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1053243) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403918) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA 61390990) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2023-03-31 |