| NPI | 1306272471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: UT 6227164-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: UT 6227164-4405) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: UT 6227164-4405) | |
| 363L00000X Nurse Practitioner (Licence: UT 6227164-4405) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: UT 6227164-4405) | |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2019-07-19 |