NPI | 1770125908 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277002326) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 28231903A) |
Enumeration Date | 2019-10-09 |
Last Update Date | 2024-08-30 |