| NPI | 1467746800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402095) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 607132) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2017-02-15 |