NPI | 1477955508 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MI 4704288196) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704288196) |
Enumeration Date | 2014-09-19 |
Last Update Date | 2023-09-19 |