NPI | 1205385432 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 6732) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CT 6732) |
Enumeration Date | 2016-09-29 |
Last Update Date | 2017-01-09 |