NPI | 1912990516 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA AP04694) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP089160) |
Enumeration Date | 2005-08-30 |
Last Update Date | 2023-10-31 |