NPI | 1720624471 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: FL 11015353) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9471464) |
Enumeration Date | 2019-11-18 |
Last Update Date | 2023-05-31 |