| NPI | 1518224559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024169740) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: VA 0024169740) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024169740) | |
| 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: VA 0024169740) | |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: VA 0024169740) | |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: VA 0024169740) | |
| 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: VA 0024169740) | |
| 364SP0811X Clinical Nurse Specialist, Psych/Mental Health, Chronically Ill (Licence: VA 0024169740) | |
| 364SP0812X Clinical Nurse Specialist, Psych/Mental Health, Community (Licence: VA 0024169740) | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2022-09-13 |