| NPI | 1225497894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 2024030602) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SPO15897) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SPO30250) | |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2024-08-21 |