| NPI | 1124328638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 33336542) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F336542) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 40401814) | |
| Enumeration Date | 2010-10-31 |
| Last Update Date | 2015-09-02 |