| NPI | 1831749720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10019946) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1089146) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61378181) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 70473) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD AC005902) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 296197) | |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2024-04-30 |