NPI | 1841534120 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010292) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DE LG - 0000623) |
Enumeration Date | 2012-11-26 |
Last Update Date | 2022-01-25 |