| NPI | 1811531148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 11004881) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11004881) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL F10191173) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 2023206940) | |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2024-06-22 |