| NPI | 1790169738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP128566) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 864972) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11025468) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0136501) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: SC APN.27723) | |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2024-04-01 |