| NPI | 1497230833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY 402431) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 641483) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2018-10-02 |