| NPI | 1912043050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 207454) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN3190512) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5002612) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 294434) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT NUR-APRN-LIC-206627) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO c-apn.0100620-c-np) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024187934) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2026-01-29 |