NPI | 1457876591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5014648) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 271994) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5014648) | |
Enumeration Date | 2017-08-10 |
Last Update Date | 2022-05-11 |