| NPI | 1366758724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F403911-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN48572) |
| 163W00000X Registered Nurse (Licence: NY 833406-01) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: RI APRN01516) | |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: RI CAPRN01516) | |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health (Licence: RI APRN01516) | |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2022-03-09 |