| NPI | 1154770824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402003) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 680984-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-06-13 |