NPI | 1184192890 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: VA 0024177111) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TN 25109) |
Enumeration Date | 2018-11-12 |
Last Update Date | 2022-01-13 |