NPI | 1568601623 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NC 5019872) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 287660) |
Enumeration Date | 2009-02-13 |
Last Update Date | 2024-05-18 |