NPI | 1801601158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 407511) |
Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IL 209.032342) |
363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11037670) | |
Enumeration Date | 2025-02-12 |
Last Update Date | 2025-09-17 |