NPI | 1336392679 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN01892) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VT 1010021563) |
Enumeration Date | 2008-10-30 |
Last Update Date | 2018-12-17 |