NPI | 1700566585 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 10011841) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201607151) |
Enumeration Date | 2023-07-18 |
Last Update Date | 2023-07-18 |