NPI | 1073158101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 079422-23) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP024903) |
Enumeration Date | 2019-11-13 |
Last Update Date | 2025-05-02 |