NPI | 1265823330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9483373) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
363L00000X Nurse Practitioner (Licence: NC 5008341) | |
363LF0000X Nurse Practitioner, Family (Licence: FL APRN9483373) | |
363LF0000X Nurse Practitioner, Family (Licence: TN 0000018806) | |
363LF0000X Nurse Practitioner, Family (Licence: NC 5008341) | |
Enumeration Date | 2015-02-11 |
Last Update Date | 2025-06-09 |