NPI | 1619390218 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: UT 10569210-4405) |
Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ AP10512) |
Enumeration Date | 2014-02-03 |
Last Update Date | 2022-09-22 |