NPI | 1548875164 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WY 48594) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: WY 16080) |
Enumeration Date | 2020-09-10 |
Last Update Date | 2021-11-23 |