NPI | 1013571561 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5011813) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NC 259677) |
Enumeration Date | 2019-04-30 |
Last Update Date | 2023-04-12 |