NPI | 1437839321 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11026930) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH23658) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F407540-01) | |
Enumeration Date | 2023-07-24 |
Last Update Date | 2025-09-26 |