| NPI | 1013599067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403396) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 728236) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2021-06-21 |