NPI | 1700555398 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 30325) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CO 104514) |
Enumeration Date | 2021-09-08 |
Last Update Date | 2025-10-01 |