| NPI | 1194418202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405724) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 221782) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN 34381) | |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2024-08-13 |