NPI | 1336697754 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11015141) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 149745) |
363LF0000X Nurse Practitioner, Family (Licence: NC 5009156) | |
363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015141) | |
Enumeration Date | 2016-09-14 |
Last Update Date | 2021-10-08 |