NPI | 1407476336 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5017612) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 201805) |
Enumeration Date | 2020-04-21 |
Last Update Date | 2024-04-09 |