NPI | 1104542109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID 58976) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61409196) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID TEMP58976) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 1112901) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI APRN-3981) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 865047) | |
Enumeration Date | 2022-10-12 |
Last Update Date | 2023-04-03 |