NPI | 1265722474 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 862324) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2011-04-10 |
Last Update Date | 2025-08-31 |