NPI | 1114609393 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 406320) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 857999-01) |
Enumeration Date | 2023-08-07 |
Last Update Date | 2024-09-03 |