| NPI | 1437689015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY F402719) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 675701) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-02-07 |