NPI | 1639402738 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2019035894) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277002897) |
363LF0000X Nurse Practitioner, Family (Licence: IL 277002897) | |
363LF0000X Nurse Practitioner, Family (Licence: MO 2019035894) | |
363LF0000X Nurse Practitioner, Family (Licence: NV 867801) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 867801) | |
Enumeration Date | 2009-09-08 |
Last Update Date | 2024-05-16 |