NPI | 1679833016 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MT 76856) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NV APRN001375) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP7767) | |
Enumeration Date | 2012-05-18 |
Last Update Date | 2023-05-16 |