| NPI | 1386017747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 403162) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 709050) |
| Enumeration Date | 2015-11-07 |
| Last Update Date | 2020-08-19 |