| NPI | 1336611656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 687686-1) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM 62825) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NH 084197-23) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2351665) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NJ 26NJ01196200) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11008307) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402700) | |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2023-03-15 |