NPI | 1700404274 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 5202116-4405) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 5202116-4405) |
Enumeration Date | 2020-07-10 |
Last Update Date | 2023-11-27 |