| NPI | 1679709505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010446) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.357-100-COA1) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ AP8015) | |
| 363L00000X Nurse Practitioner (Licence: OH COA.11347-NP) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP8015) | |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2023-06-27 |