NPI | 1023181534 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI 03339) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 2192) |
363LF0000X Nurse Practitioner, Family (Licence: CT 2192) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 2192) | |
Enumeration Date | 2006-11-15 |
Last Update Date | 2023-03-22 |