| NPI | 1639587009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401727) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA RN2388649) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 277001509) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95016396) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2024-07-01 |