NPI | 1093293383 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402391) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 684280) |
Enumeration Date | 2018-07-30 |
Last Update Date | 2018-07-30 |