NPI | 1386334399 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F406149-01) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 722038-01) |
Enumeration Date | 2023-05-11 |
Last Update Date | 2024-07-24 |