NPI | 1346712353 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP028389) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP019800) |
Enumeration Date | 2019-01-02 |
Last Update Date | 2023-12-21 |