| NPI | 1679252027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 206593) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406045) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 321232) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1143578) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024189159) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10027568) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704435172) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 14200300-4405) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO APN.0102818-C-NP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61661385) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11027857) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 83048) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0137736TELE) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP030665) | |
| Enumeration Date | 2023-07-13 |
| Last Update Date | 2025-10-21 |