| NPI | 1407569817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11042205) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA NP004147) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP035653) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP251894) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 5385388081) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71017854A) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 0041464) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2026018306) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209035574) | |
| Enumeration Date | 2022-12-30 |
| Last Update Date | 2026-05-22 |