| NPI | 1245749738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F403292-01) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2017033627) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2023-08-31 |