| NPI | 1235777343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NY 577897) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: NY 577897) |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2019-12-19 |