NPI | 1659443125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F400683) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 012391) |
Enumeration Date | 2006-11-14 |
Last Update Date | 2013-02-26 |