| NPI | 1497282909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM CNP03316) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM CNP-03316) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9340971) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9340971) | |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2024-07-12 |