NPI | 1417722752 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407116) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 907566) |
Enumeration Date | 2023-11-16 |
Last Update Date | 2025-09-24 |