NPI | 1598933830 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11013794) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN CNP3627) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209015485) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 3881-33) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60759980) | |
Enumeration Date | 2008-02-20 |
Last Update Date | 2022-10-16 |