NPI | 1669095907 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 28256) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9488515) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11008981) | |
Enumeration Date | 2020-05-21 |
Last Update Date | 2022-01-14 |