NPI | 1417565615 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 214496) |
Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA 214496) |
Enumeration Date | 2020-07-14 |
Last Update Date | 2025-01-02 |