| NPI | 1174014096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402454) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 674326) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2018-07-10 |