| NPI | 1265813703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 403266) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 696605) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2020-10-16 |