NPI | 1407378128 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family (Licence: FL APRN9361022) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9361022) |
363LF0000X Nurse Practitioner, Family (Licence: NY 343196) | |
Enumeration Date | 2017-07-14 |
Last Update Date | 2023-06-19 |