| NPI | 1538307897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM CNP-01985) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-07579) |
| 163W00000X Registered Nurse (Licence: NM RN-71946) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95012483) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP4713) | |
| Enumeration Date | 2009-01-25 |
| Last Update Date | 2024-01-31 |