| NPI | 1508653296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5022049) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61679477) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11038955) | |
| Enumeration Date | 2025-04-24 |
| Last Update Date | 2025-07-16 |