| NPI | 1285249540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1046850) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 942541) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61187130) | |
| 363LF0000X Nurse Practitioner, Family (Licence: DE LG-0011717) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61187130) | |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2024-11-11 |