| NPI | 1457003816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 403997) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 403997) |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2023-07-17 |