NPI | 1669177846 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5021345) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA 286494) |
Enumeration Date | 2023-04-05 |
Last Update Date | 2025-03-19 |