| NPI | 1306392246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402198) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 689712) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2022-07-21 |