NPI | 1699149492 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R193260) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R193260) |
Enumeration Date | 2015-11-18 |
Last Update Date | 2019-09-30 |