NPI | 1992055271 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R174190) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R174190) |
363LF0000X Nurse Practitioner, Family (Licence: DC RN1016041) | |
Enumeration Date | 2012-09-14 |
Last Update Date | 2020-05-13 |