| NPI | 1255747184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 401862) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: NY 430819) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2019-05-05 |