| NPI | 1689895245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 12785) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 141683) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AR 225137) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 906011) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003113) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 12785) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MS 901353) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2025-01-05 |