NPI | 1639591324 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA AP07636) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07636) |
Enumeration Date | 2014-01-14 |
Last Update Date | 2025-01-28 |