NPI | 1225661002 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NV rn71078) |
Additional Taxonomies | 183500000X Pharmacist (Licence: NV 20225) |
Enumeration Date | 2020-02-19 |
Last Update Date | 2021-01-05 |