| NPI | 1568295954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 884594) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN67997) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NV RN67997) | |
| Enumeration Date | 2024-08-22 |
| Last Update Date | 2024-11-27 |