| NPI | 1003352329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NY 825659) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 290544) |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2024-06-05 |