| NPI | 1942330014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: VA 0024186428) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: NY 873397-01) |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: TN RN0000135328) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TN APN14483) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CO C-APN.0100144-C-NP) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F404803-01) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2025-10-22 |