| NPI | 1003121674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 404570) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 338439-1) |
| 364SP0813X Clinical Nurse Specialist, Psych/Mental Health, Geropsychiatric (Licence: TX 1058952) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 005636) | |
| 163W00000X Registered Nurse (Licence: NY 611372) | |
| Enumeration Date | 2010-08-08 |
| Last Update Date | 2024-11-05 |