| NPI | 1083930663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5013569) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: SC 20187) |
| 363LF0000X Nurse Practitioner Family (Licence: VA 0024178379) | |
| 363LF0000X Nurse Practitioner Family (Licence: SC 20187) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MI 4704252348) | |
| 363LF0000X Nurse Practitioner Family (Licence: MI 4704252348) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: VA 0024178379) | |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2024-07-30 |