NPI | 1972283844 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: KY 4028613) |
Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: IN 28266641A) |
Enumeration Date | 2023-07-24 |
Last Update Date | 2024-10-08 |