NPI | 1417207051 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024174031) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 803743) |
Enumeration Date | 2012-09-11 |
Last Update Date | 2016-10-27 |