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 |