| NPI | 1518544477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209025957) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA 61442753) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10010368) | |
| 163WG0000X Registered Nurse, General Practice (Licence: IL 041424649) | |
| 163WG0000X Registered Nurse, General Practice (Licence: WA RN61442743) | |
| 163WG0000X Registered Nurse, General Practice (Licence: OR 10010368) | |
| 163WG0000X Registered Nurse, General Practice (Licence: TX 1048426) | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2023-07-24 |