NPI | 1962116905 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: LA 220378) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: LA 220378) |
Enumeration Date | 2023-01-12 |
Last Update Date | 2023-03-07 |