| NPI | 1306890629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 400825) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 398433) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2008-05-13 |