NPI | 1063425429 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MN 2459247) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA RN 505988 NP11030) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA RN 505988 NP11030) | |
Enumeration Date | 2006-08-15 |
Last Update Date | 2022-07-21 |