NPI | 1104133750 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406442) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 2264827) |
Enumeration Date | 2010-09-02 |
Last Update Date | 2025-01-27 |