| NPI | 1265795157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403361) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 332172) |
| Enumeration Date | 2012-06-17 |
| Last Update Date | 2023-04-11 |