| NPI | 1912675554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1049285) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61222075) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405451) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 264681) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO C-APN.0003596-C-NP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G165199) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 202110667NP-PP) | |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2024-08-07 |