NPI | 1285811026 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 355928) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 355928) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 355928) | |
Enumeration Date | 2008-01-23 |
Last Update Date | 2008-01-23 |