NPI | 1013568153 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407386) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 344643) |
363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01039400) | |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01039400) | |
Enumeration Date | 2019-09-20 |
Last Update Date | 2025-08-06 |