| NPI | 1184211559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F404242) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F404242-01) | |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2022-10-10 |