NPI | 1124328638 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 33336542) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F336542) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 40401814) | |
Enumeration Date | 2010-10-31 |
Last Update Date | 2015-09-02 |