NPI | 1134795214 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN264103) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA MR6510328) |
Enumeration Date | 2021-05-31 |
Last Update Date | 2024-03-18 |