NPI | 1710367453 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP9749) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN204465) |
163W00000X Registered Nurse (Licence: FL RN9358059) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL ARNP9358059) | |
Enumeration Date | 2015-06-08 |
Last Update Date | 2018-05-24 |