| NPI | 1740860964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11015200) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11015200) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 311259) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP029824) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP251347) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OH APRN.CNP.0033961) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP032075) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F406063) | |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2025-12-09 |