| NPI | 1003405713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403684) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 732940) |
| 164W00000X Licensed Practical Nurse (Licence: NY 302177) | |
| Enumeration Date | 2021-01-16 |
| Last Update Date | 2021-11-01 |