NPI | 1700541042 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 65684) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ RN169587) |
163WP0808X Registered Nurse, Psych/Mental Health (Licence: MA 163WP0808X) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2309461) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 263686) | |
Enumeration Date | 2021-11-02 |
Last Update Date | 2023-05-15 |