NPI | 1598382004 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 10163) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 10163) |
Enumeration Date | 2020-06-30 |
Last Update Date | 2025-04-11 |