| NPI | 1114944683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71014550A) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OK R0045798) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WV 75862) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WV 75862) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WV 75862) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WV 75862) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 252761) | |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: WV 75862) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-04-22 |