NPI | 1831605658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10690) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP10690) |
363LF0000X Nurse Practitioner, Family (Licence: MA RN2257932) | |
Enumeration Date | 2017-12-15 |
Last Update Date | 2021-10-27 |