| NPI | 1467247809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406889) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11038089) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH 0038714) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61685345) | |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2025-07-28 |