| NPI | 1609649987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95028026) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11029482) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 306307) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61501281) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10005209) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1139024) | |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-06-25 |