| NPI | 1245098979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 405564) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 402272) |
| 163W00000X Registered Nurse (Licence: NY 523838) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 306109) | |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-07 |