NPI | 1528668118 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OK R0112063) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OK R0112063) |
Enumeration Date | 2020-10-31 |
Last Update Date | 2021-07-22 |