| NPI | 1679125686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ 231793) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX AP142768) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IL 209.019899) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO 1652) | |
| Enumeration Date | 2019-07-10 |
| Last Update Date | 2023-01-10 |