NPI | 1447710223 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA GAA-NP000383) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 903253) |
363LF0000X Nurse Practitioner, Family (Licence: AL 3-001314) | |
Enumeration Date | 2019-03-20 |
Last Update Date | 2023-10-10 |