NPI | 1699909283 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MD AC001965) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5004355) |
Enumeration Date | 2009-05-11 |
Last Update Date | 2017-03-09 |