| NPI | 1194109744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61303774) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307386) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F348698-01) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00578600) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00578600) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NJ 26NJ00578600) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 307386) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404894) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ00578600) | |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2024-01-04 |