NPI | 1255735700 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3008991) |
Additional Taxonomies | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: KY 3008991) |
Enumeration Date | 2014-10-13 |
Last Update Date | 2023-04-04 |