NPI | 1447951330 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R194509) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R194509) |
Enumeration Date | 2023-03-16 |
Last Update Date | 2024-07-11 |