NPI | 1023757937 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-190092) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-190092) |
Enumeration Date | 2022-05-31 |
Last Update Date | 2025-10-01 |