NPI | 1700339785 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5008664) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 234451) |
Enumeration Date | 2016-07-26 |
Last Update Date | 2020-10-27 |