| NPI | 1205593852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403900) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 950273) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2023-03-07 |