NPI | 1861080343 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 28758) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 247954) |
Enumeration Date | 2021-01-09 |
Last Update Date | 2021-01-22 |