NPI | 1285246389 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 28130) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 240649) |
Enumeration Date | 2020-08-19 |
Last Update Date | 2024-07-03 |