NPI | 1790901668 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: HI APRN-4861) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95329837) |
Enumeration Date | 2007-04-18 |
Last Update Date | 2024-10-30 |