NPI | 1497935142 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405352) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ15050900) |
363LF0000X Nurse Practitioner, Family (Licence: NY 33 336007) | |
363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: NY 35 350259) | |
Enumeration Date | 2007-11-10 |
Last Update Date | 2025-08-14 |