NPI | 1205388337 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL 11009517) |
Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: TX AP132378) |
Enumeration Date | 2016-10-24 |
Last Update Date | 2021-07-01 |