NPI | 1598141715 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP015194) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R235810) |
Enumeration Date | 2015-08-11 |
Last Update Date | 2025-02-18 |