| NPI | 1104523372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F404972) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 729031-01) |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2023-06-20 |