| NPI | 1639701022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AR 124003) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0136702TELE) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-80978-011) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1108659) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5017307) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024186793) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209029015) | |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: AR R090467) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407812) | |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2025-12-08 |