| NPI | 1619722998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NV 816367) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV 816367) |
| Enumeration Date | 2024-04-20 |
| Last Update Date | 2024-08-12 |