| NPI | 1194005520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401687) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 337007) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2014-09-04 |