NPI | 1376882191 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN188113) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA 188113) |
Enumeration Date | 2013-02-14 |
Last Update Date | 2019-08-26 |