| 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 |