| NPI | 1437547957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 401641) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: NY 629706) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2015-01-06 |