NPI | 1225552292 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F403703-01) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F307838) |
Enumeration Date | 2017-08-01 |
Last Update Date | 2022-04-04 |