NPI | 1962037770 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KS 5379195072) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2019081674) |
Enumeration Date | 2020-03-12 |
Last Update Date | 2020-03-18 |