NPI | 1609364520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5016124) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 28169) |
163W00000X Registered Nurse (Licence: NC 281689) | |
Enumeration Date | 2018-04-26 |
Last Update Date | 2023-01-16 |