| NPI | 1659017374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11021532) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 50835) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 74098) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 089637-23) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ND R53168) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 53-81592-042) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010372) | |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: TX 1096480) | |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2023-10-20 |