| NPI | 1124839238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NY 58671401) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 58671401) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 58671401) | |
| Enumeration Date | 2025-01-17 |
| Last Update Date | 2025-01-17 |