NPI | 1669080933 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024179871) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 2371434) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CT 011163) | |
Enumeration Date | 2020-07-22 |
Last Update Date | 2023-03-06 |