NPI | 1497103675 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP016757) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN662573) |
Enumeration Date | 2016-05-30 |
Last Update Date | 2022-09-13 |