NPI | 1821178476 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F400794-1) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 011739-1) |
163W00000X Registered Nurse (Licence: NY 533159) | |
363LA2200X Nurse Practitioner Adult Health (Licence: NY F305760-1) | |
Enumeration Date | 2006-10-17 |
Last Update Date | 2016-03-01 |