| NPI | 1215587365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R263594) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: DC RN1047416) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 976325) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: DC RN1047416) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC RN1047416) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R263594) | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2024-03-06 |