NPI | 1164889044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5008307) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5008307) |
Enumeration Date | 2016-01-22 |
Last Update Date | 2023-04-13 |