NPI | 1134763576 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 234094) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: LA RN158835) |
Enumeration Date | 2019-10-29 |
Last Update Date | 2024-04-10 |