NPI | 1265215602 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN322175) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN322175) |
Enumeration Date | 2023-08-18 |
Last Update Date | 2024-05-20 |