| NPI | 1437636883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F405161-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9190560) |
| 163W00000X Registered Nurse (Licence: NY 805865) | |
| Enumeration Date | 2018-07-27 |
| Last Update Date | 2024-10-21 |