NPI | 1609567957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IN 71014117A) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R220189-4) |
163W00000X Registered Nurse (Licence: IN 28235293A) | |
Enumeration Date | 2023-05-17 |
Last Update Date | 2023-08-02 |