NPI | 1407629975 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R236391) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: DC RN1055358) |
Enumeration Date | 2023-11-06 |
Last Update Date | 2025-09-17 |