| NPI | 1407254022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN174455) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2018034790) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN174455) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 5881) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201803616NP-PP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60851716) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 8415-33) | |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2019-05-08 |