NPI | 1992253082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AL 3-001136) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 905672) |
163WP0808X Registered Nurse, Psych/Mental Health (Licence: MS R895162) | |
Enumeration Date | 2016-09-17 |
Last Update Date | 2023-11-21 |