| NPI | 1457048860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 5670596-4405) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 53888) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 5670596-4405) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 79057) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 53888) | |
| 363LF0000X Nurse Practitioner, Family (Licence: ID 79057) | |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2026-07-10 |