NPI | 1538432703 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 10493) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 44680) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 10503499-4405) | |
Enumeration Date | 2012-02-17 |
Last Update Date | 2023-07-27 |