| NPI | 1265807440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 404205) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 628799) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2022-11-29 |