NPI | 1578970786 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401921-1) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 672954) |
Enumeration Date | 2014-07-20 |
Last Update Date | 2020-01-31 |