NPI | 1154899805 |
---|---|
Former Name | AUDREY CAVINS |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61025837) |
Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KY 3012865) |
Enumeration Date | 2018-11-10 |
Last Update Date | 2024-04-19 |