| NPI | 1972507424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV APRN001009) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001009) |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 19498.278) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ME CNP231609) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 223685) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 5738) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10008793) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2023-11-09 |