NPI | 1922094903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 236171) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ RN129664) |
Enumeration Date | 2005-09-23 |
Last Update Date | 2009-01-29 |