NPI | 1023072519 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AZ AP3376) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP3313) |
364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: AZ AP3314) | |
Enumeration Date | 2006-04-13 |
Last Update Date | 2018-08-10 |