NPI | 1619311966 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL 3402612) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 73 027835) |
163W00000X Registered Nurse (Licence: FL 3402612) | |
Enumeration Date | 2013-04-17 |
Last Update Date | 2016-05-12 |