NPI | 1639685126 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN9331860) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9331860) |
Enumeration Date | 2017-12-19 |
Last Update Date | 2024-09-06 |