NPI | 1083487698 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407139) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 013311) |
163W00000X Registered Nurse (Licence: NY 90865401) | |
Enumeration Date | 2023-11-06 |
Last Update Date | 2025-06-09 |