NPI | 1316563927 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11006682) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11006682) |
Enumeration Date | 2020-06-19 |
Last Update Date | 2025-08-19 |