| NPI | 1598933830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11013794) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN CNP3627) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209015485) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 3881-33) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60759980) | |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2022-10-16 |