NPI | 1700575123 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R237210) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD R237210) |
Enumeration Date | 2023-05-02 |
Last Update Date | 2024-02-20 |