NPI | 1497107403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: KY 3011914) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3011914) |
363LF0000X Nurse Practitioner Family (Licence: IN 71006358A) | |
363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KY 3011914) | |
Enumeration Date | 2016-07-01 |
Last Update Date | 2023-09-27 |