NPI | 1467025981 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3016305) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 3016305) |
Enumeration Date | 2021-07-22 |
Last Update Date | 2023-03-28 |