| NPI | 1093243537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405077) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 730345) |
| Enumeration Date | 2017-05-29 |
| Last Update Date | 2023-09-09 |