| NPI | 1205146941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 401302) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AK 1478) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401302-1) | |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2024-06-13 |