NPI | 1316170509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP010989) |
Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: PA RN618876) |
Enumeration Date | 2009-09-03 |
Last Update Date | 2022-09-29 |