NPI | 1164835211 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2277612) |
Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F401696) |
Enumeration Date | 2014-06-06 |
Last Update Date | 2021-07-06 |