| NPI | 1326030495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F401552) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F333603-1) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2022-04-01 |