NPI | 1174365563 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NE 115505) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 62325) |
Enumeration Date | 2024-06-07 |
Last Update Date | 2024-09-11 |