NPI | 1205346335 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CT 7277) |
Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CT 7277) |
Enumeration Date | 2017-10-03 |
Last Update Date | 2019-01-15 |