NPI | 1235706250 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024182462) |
Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: VA 0001251821) |
Enumeration Date | 2021-06-08 |
Last Update Date | 2021-08-18 |