NPI | 1215672308 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 1-139148) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 10687) |
Enumeration Date | 2022-05-03 |
Last Update Date | 2022-10-12 |