| NPI | 1487096780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL ARNP9444970) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: GA RN124311) |
| 163WR0400X Registered Nurse Rehabilitation (Licence: GA RN124311) | |
| 163W00000X Registered Nurse (Licence: GA RN124311) | |
| 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: GA RN124311) | |
| 163WG0000X Registered Nurse General Practice (Licence: GA RN124311) | |
| 163WH0200X Registered Nurse Home Health (Licence: GA RN124311) | |
| 163WW0000X Registered Nurse Wound Care (Licence: GA RN124311) | |
| Enumeration Date | 2013-07-27 |
| Last Update Date | 2018-03-19 |