NPI | 1427400720 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL 9328438) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9328438) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9328438) | |
Enumeration Date | 2016-07-11 |
Last Update Date | 2022-01-26 |