| NPI | 1174867428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 136437) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK 34122) |
| 363LF0000X Nurse Practitioner, Family (Licence: AK 136437) | |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2024-03-21 |