NPI | 1477098606 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402484) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 648536) |
Enumeration Date | 2016-12-26 |
Last Update Date | 2018-07-30 |