NPI | 1790180727 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R189470) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD R189470) |
Enumeration Date | 2014-11-04 |
Last Update Date | 2023-01-27 |