NPI | 1770180739 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DC NP64283) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: MD R125983) |
Enumeration Date | 2020-10-02 |
Last Update Date | 2022-11-21 |