| NPI | 1154613479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 813247) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA H139284) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MN 5832) | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2020-12-17 |