NPI | 1821481466 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: MO 2014020742) |
Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KS 5380755051) |
Enumeration Date | 2015-03-06 |
Last Update Date | 2021-12-10 |