NPI | 1750861621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NE 112557) |
Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NE 112557) |
363LA2200X Nurse Practitioner, Adult Health (Licence: NE 112557) | |
Enumeration Date | 2018-08-20 |
Last Update Date | 2023-03-06 |