NPI | 1306217690 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9310398) |
Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL APRN9310398) |
Enumeration Date | 2015-10-13 |
Last Update Date | 2021-11-02 |