| NPI | 1720846058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IA G178551) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TN 36162) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ 305418) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KS 53-83973-011) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX 1197797) | |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2025-05-23 |