NPI | 1003159070 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11018626) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9548024) |
163W00000X Registered Nurse (Licence: IL 209025036) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209025036) | |
Enumeration Date | 2013-03-28 |
Last Update Date | 2024-09-27 |