| NPI | 1407112204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2021027727) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2012006273) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AR 232029) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 78961) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277003667) | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2025-12-09 |