| NPI | 1477199198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ 272063) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CA 95022500) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX AP144170) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IA G157059) | |
| Enumeration Date | 2019-11-18 |
| Last Update Date | 2024-05-05 |