NPI | 1598193989 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401869) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307355) |
Enumeration Date | 2013-10-22 |
Last Update Date | 2025-09-19 |