| NPI | 1144621590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F402504-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 663317-1) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2018-08-14 |