NPI | 1952059776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 296237) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: AZ RN181480) |
Enumeration Date | 2022-03-10 |
Last Update Date | 2024-09-06 |