| NPI | 1366830234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ ap10782) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 201408698NP-PP) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10782) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.025257) | |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2022-06-15 |