NPI | 1184207680 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024181592) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: VA 0001259386) |
Enumeration Date | 2021-05-03 |
Last Update Date | 2024-09-29 |