| NPI | 1225355787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024170972) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 504869) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F40131321) | |
| 163W00000X Registered Nurse (Licence: VA 0001233424) | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2016-08-16 |