NPI | 1548077910 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10036040) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 31550) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA 361644690) | |
Enumeration Date | 2024-12-18 |
Last Update Date | 2024-12-18 |