| NPI | 1952088189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406939) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP002119) |
| 163W00000X Registered Nurse (Licence: FL RN9357984) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010793) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN04580) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11028660) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11028660) | |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2026-02-03 |