| NPI | 1801296090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00521100) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 101.0136259TELE) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401760-01) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 085625-23) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11008616) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2346768) | |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2024-03-10 |