| NPI | 1689429680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: UT 11772561-4405) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MT NUR-APRN-LIC-240395) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: ID 79207) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ 307248) | |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-07-02 |