| NPI | 1477993830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: IA G172201) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA A116028) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: IA A116028) | |
| 363LF0000X Nurse Practitioner Family (Licence: IA A116028) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: IA A116028) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2023-04-13 |