| NPI | 1457994576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP142933) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2384899) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202213901NP-PP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024180323) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0136770) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 091187-23) | |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2026-09-22 |