NPI | 1952013013 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD R180346) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010399) |
Enumeration Date | 2022-12-21 |
Last Update Date | 2025-08-20 |