| NPI | 1023324506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402793) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 634131) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2023-07-27 |