| NPI | 1851180418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11041859) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R233475) |
| 163W00000X Registered Nurse (Licence: MD R233475) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024194827) | |
| 163W00000X Registered Nurse (Licence: DC RN500327292) | |
| Enumeration Date | 2025-05-01 |
| Last Update Date | 2025-10-06 |