| NPI | 1518456326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010376) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 112430) |
| 363LF0000X Nurse Practitioner, Family (Licence: DE L1-0070520) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R246624) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AK 133421) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R246624) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP027703) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024188760) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2024-02-07 |