| NPI | 1134603020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9275253) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9275253) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 9275253) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL 9275253) | |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2022-07-28 |