| NPI | 1871947291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 002915) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA F95003567) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F340204-1) | |
| 363LF0000X Nurse Practitioner, Family (Licence: HI 2169) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI 2169) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 002915) | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2024-06-12 |