NPI | 1558603506 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RNTEMP17124) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP012899) |
Enumeration Date | 2013-03-17 |
Last Update Date | 2022-07-21 |