| NPI | 1063067346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 11839389-4405) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: RI APRN02110) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 11839389-4409) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: UT 11839389-4409) | |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2022-08-10 |