NPI | 1023099637 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WY 19109.0857) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: WY 19109.0857) |
364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health (Licence: WY 19109.0857) | |
Enumeration Date | 2005-11-10 |
Last Update Date | 2016-11-09 |