| NPI | 1093205676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 402766) |
| Additional Taxonomies | 163WH0200X Registered Nurse Home Health (Licence: NY 711302) |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: NJ 26NR18865500) | |
| 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: CT 166816) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NJ 26NJ01170200) | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: CT 11875) | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2024-09-12 |