NPI | 1023442654 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 5437-33) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 5437) |
Enumeration Date | 2013-08-30 |
Last Update Date | 2019-08-01 |