| NPI | 1235580978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: CA 95011629) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402019) |
| 163W00000X Registered Nurse (Licence: NY 715835) | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2021-03-09 |